By Kim Maryniak, RNC, MSN
There are many medications that we give patients that can cause accidental overdose, either through dosing, pharmacological interactions, or physiological contributory factors. It is important that we know the appropriate antidote in case any of these situations occur.
Acetaminophen is a common ingredient in many prescribed and over-the-counter medications. One of the biggest concerns is liver toxicity in patients. Acetylcysteine (Mucomyst ®) is the antidote for acetaminophen accumulation and overdose, administered either in oral or intravenous form.
Management of pain and anxiety, and providing conscious sedation can also put our patients at risk. Naloxone (Narcan®) is the antidote for narcotics, such as morphine, dilaudid, and fentanyl. Intravenous administration is preferred, although intramuscular injection can be given. Flumazenil (Romazicon®) is the antidote for benzodiazepines, such as diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®), and must be administered intravenously.
There are two important reversal agents to remember:
Other medications that are commonly administered to patients include digoxin, heparin and warfarin. Digoxin’s antidote is digoxin immune Fab (Digibind®), given through intravenous infusion or, if urgent, rapid intravenous injection. For severe heparin overdose or hemorrhagic risk, protamine sulfate is used as the antidote, through slow intravenous injection. Warfarin (Coumadin®) overdose is treated with vitamin K or phytonadione (Phylloquinone®). Vitamin K can be given by either oral, intramuscular, subcutaneous, or intravenous routes. Although effective with warfarin overdoses, vitamin K has no effect with heparin.
Although these are some of the common medications we administer, the list is longer. If you have a medication that you are concerned may cause an overdose, refer to your resources at your facility, and contact your pharmacy.
Well, B., DiPiro, J., Schwinghammer, T. & DiPiro, C. (2009). Pharmacotherapy handbook (7th Ed.). NY: The McGraw-Hill Companies, Inc.
© 2012. AMN Healthcare, Inc. All Rights Reserved.
Kim Maryniak, RNC, MSN is currently a Clinical Director with AMN Healthcare. She has more than 22 years of nursing experience, including med/surg, psychiatry, pediatrics, neonatal intensive care, education and management.